Coumadin-Induced Skin Necrosis

Janice M. Beitz, PhD, RN, CS, CNOR, CWOCN


Wounds. 2002;14(6) 

In This Article

Abstract and Introduction


Coumadin-induced skin necrosis is a rare, but well-recognized, skin and soft-tissue complication of oral anticoagulation therapy. Although a typical clinical pattern has been partially identified and theories of pathogenesis posed, the resultant injury can be so significant and the lesions so recalcitrant to conservative treatment that the condition remains a major diagnostic and therapeutic challenge. Well-informed clinicians suspicious of impending Coumadin-induced skin necrosis can intervene quickly to alter the course and prevent its significant morbidity and potential mortality.


Coumadin-induced skin necrosis (CISN) is a rare, unusual, and unpredictable integumentary complication of anticoagulant therapy. Also known as warfarin-induced skin necrosis (WISN), the dermatologic complication occurs in 0.01 to 0.1 percent of warfarin-treated patients. As anticoagulation is a component of therapy for many major chronic illnesses, recognition of the condition is crucial for prompt intervention in clinical practice. The syndrome also can result in substantial morbidity and possible fatality. This article addresses the historical background, pathogenesis, clinical presentation, and prevention/treatment issues associated with CISN.


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